{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T20:08:37Z","timestamp":1787170117689,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2019,9,30]],"date-time":"2019-09-30T00:00:00Z","timestamp":1569801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The goal of this study is to compare the risk of lower extremity lymphedema (LEL) between pelvic external beam radiation therapy (EBRT) and vaginal brachytherapy, and to identify risk factors for LEL in gynecologic cancer patients treated with adjuvant radiation therapy (RT) after radical surgery. A total of 263 stage I\u2013III gynecologic cancer patients who underwent adjuvant RT were retrospectively reviewed. One-to-one case-matched analysis was conducted with propensity scores generated from patient, tumor, and treatment characteristics. Using the risk factors found in this study, high- and low-risk groups were identified. With a median follow-up of 36.0 months, 35 of 263 (13.3%) patients developed LEL. In multivariate analysis, laparoscopic surgery (HR 2.548; p = 0.024), harvesting more than 30 pelvic lymph nodes (HR 2.246; p = 0.028), and para-aortic lymph node dissection (PALND, HR 2.305; p = 0.014) were identified as independent risk factors for LEL. After propensity score matching, the LEL incidence of the brachytherapy group was significantly lower than the EBRT group (p = 0.025). In conclusion, high-risk patients with risk factors such as laparoscopic surgery, harvesting more than 30 pelvic lymph nodes, PALND, and adjuvant pelvic EBRT require closer observation for LEL.<\/jats:p>","DOI":"10.3390\/cancers11101471","type":"journal-article","created":{"date-parts":[[2019,9,30]],"date-time":"2019-09-30T05:58:33Z","timestamp":1569823113000},"page":"1471","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Lower Extremity Lymphedema in Gynecologic Cancer Patients: Propensity Score Matching Analysis of External Beam Radiation versus Brachytherapy"],"prefix":"10.3390","volume":"11","author":[{"given":"Won Ick","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Cheol","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Gyun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Korea"},{"name":"Cancer Research Institute, Seoul National University, Seoul 03080, Korea"},{"name":"Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hak Jae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Hyuck","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8017-3176","authenticated-orcid":false,"given":"Maria","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Seung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Hoon","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Weon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noh Hyun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7115-4021","authenticated-orcid":false,"given":"Yong Sang","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan-Sik","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.ygyno.2014.03.003","article-title":"Quality of life of women with lower limb swelling or lymphedema 3\u20135 years following endometrial cancer","volume":"133","author":"Rowlands","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1002\/cncr.22217","article-title":"The European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life questionnaire cervical cancer module: EORTC QLQ-CX24","volume":"107","author":"Greimel","year":"2006","journal-title":"Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.suronc.2016.05.015","article-title":"Lower-extremity lymphedema following management for endometrial and cervical cancer","volume":"25","author":"Mendivil","year":"2016","journal-title":"Surg. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/AOG.0000000000000372","article-title":"Lymphedema after surgery for endometrial cancer: Prevalence, risk factors, and quality of life","volume":"124","author":"Yost","year":"2014","journal-title":"Obstet. Gynecol."},{"key":"ref_5","first-page":"174","article-title":"Alterations of Untreated Lymphedema and It Grade Over Time","volume":"28","year":"1995","journal-title":"Lymphology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1001\/archsurg.1967.01330080061017","article-title":"Lymphangiosarcoma: A Lethal Complication of Chronic Lymphedema: Report of Two Cases and Review of the Literature","volume":"94","author":"Eby","year":"1967","journal-title":"Arch. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/0090-8258(85)90221-5","article-title":"Lymphangiosarcoma of the edematous thigh after radiation therapy for carcinoma of the vulva","volume":"20","author":"Huey","year":"1985","journal-title":"Gynecol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"228","DOI":"10.3857\/roj.2011.29.4.228","article-title":"The influence of adjuvant radiotherapy on patterns of failure and survivals in uterine carcinosarcoma","volume":"29","author":"Park","year":"2011","journal-title":"Radiat. Oncol. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ygyno.2016.10.037","article-title":"Identifying risk factors for occult lower extremity lymphedema using computed tomography in patients undergoing lymphadenectomy for gynecologic cancers","volume":"144","author":"Kim","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1097\/IGC.0b013e3182466950","article-title":"Incidence and risk factors of lower-extremity lymphedema after radical surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer","volume":"22","author":"Kim","year":"2012","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1245\/s10434-015-4613-1","article-title":"Postoperative Lower Extremity Edema in Patients with Primary Endometrial Cancer","volume":"23","author":"Bae","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12905-017-0403-1","article-title":"Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: A hospital-based retrospective cohort study","volume":"17","author":"Kuroda","year":"2017","journal-title":"BMC Womens Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1007\/s10147-010-0171-5","article-title":"Risk factors for lower-limb lymphedema after surgery for cervical cancer","volume":"16","author":"Ohba","year":"2011","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ygyno.2014.11.006","article-title":"Incidence, risk factors and estimates of a woman\u2019s risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer","volume":"136","author":"Beesley","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1097\/IGC.0000000000000509","article-title":"Assessing the quality of life in patients with endometrial cancer treated with adjuvant radiotherapy","volume":"25","author":"Karabuga","year":"2015","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.gore.2015.12.002","article-title":"A prospective pilot study on the incidence of post-operative lymphedema in women with endometrial cancer","volume":"15","author":"Hopp","year":"2016","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1007\/s10147-014-0724-0","article-title":"Incidence and risk factors for lower limb lymphedema after gynecologic cancer surgery with initiation of periodic complex decongestive physiotherapy","volume":"20","author":"Deura","year":"2015","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1046\/j.0004-8666.2003.00040.x","article-title":"Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer","volume":"43","author":"Ryan","year":"2003","journal-title":"Aust. New Zeal. J. Obstet. Gynaecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3802\/jgo.2016.27.e4","article-title":"The risk of lymphedema after postoperative radiation therapy in endometrial cancer","volume":"27","author":"Mitra","year":"2016","journal-title":"J. Gynecol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.ygyno.2015.07.003","article-title":"Close relationship between removal of circumflex iliac nodes to distal external iliac nodes and postoperative lower-extremity lymphedema in uterine corpus malignant tumors","volume":"139","author":"Todo","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.ajog.2011.03.012","article-title":"Adverse events associated with laparoscopy vs. laparotomy in the treatment of endometrial cancer","volume":"205","author":"Barnett","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00404-003-0488-7","article-title":"Clinical outcome and complications of laparoscopic surgery compared with traditional surgery in women with endometrial cancer","volume":"270","author":"Kuoppala","year":"2004","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/S0360-3016(02)02971-1","article-title":"Operable Stages IB and II cervical carcinomas: A retrospective study comparing preoperative uterovaginal brachytherapy and postoperative radiotherapy","volume":"54","author":"Atlan","year":"2002","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1016\/j.ejca.2011.11.014","article-title":"Five-year quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data","volume":"48","author":"Nout","year":"2012","journal-title":"Eur. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/IGC.0b013e3181d7ce94","article-title":"Survival and disease relapse in surgical stage I endometrioid adenocarcinoma of the uterus after adjuvant vaginal vault brachytherapy","volume":"20","author":"Kumar","year":"2010","journal-title":"Int. J. Gynecol. 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